Korean J Orthod.  2022 Sep;52(5):362-371. 10.4041/kjod22.023.

Camouflage treatment by backward rotation of the mandible for a severe skeletal Class III malocclusion with aplastic anemia: A case report

• Choi DS
• Lee DH
• Jang I
• Cha BK

• KMID: 2533261
• DOI: http://doi.org/10.4041/kjod22.023

Abstract

Orthognathic surgery is the primary treatment option for severe skeletal discrepancy. However, orthodontic camouflage should be considered as an alternative treatment option, considering the risks of surgery. A 19.5-yearold man presented with a severe prognathic mandible with a Class III molar relationship and an anterior crossbite. Orthognathic surgery could be considered because of his severe skeletal discrepancy and mandibular prognathism. However, the anesthetist for orthognathic surgery did not recommend surgery under general anesthesia because of risk factors associated with the patient’s aplastic anemia, including bleeding and infections. Thus, a camouflage treatment to promote backward rotation of the mandible via orthodontic extrusion of the posterior teeth was planned. An anterior bite plate, intermaxillary elastics, and fixed orthodontic appliances were used to extrude the posterior teeth and to align the dentition. After 17 months of nonsurgical orthodontic treatment, normal occlusion was achieved, and the facial profile was dramatically improved. This case report describes the dentoskeletal and soft-tissue effects of mandibular rotation and its long-term stability.

Keyword

Class III treatment; Soft tissue; Adult treatment; Aplastic anemia

Figure

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  Figure 1 Pretreatment facial and intraoral photographs.

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  Figure 2 Pretreatment dental casts.

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  Figure 3 Pretreatment panoramic and lateral cephalometric radiographs.

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  Figure 4 Lateral cephalometric radiograph taken in anterior edge-to-edge bite and description of orthodontic treatment plan to extrude the posterior teeth using vertical elastics and an anterior bite plate.

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  Figure 5 Treatment progress.

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  Figure 6 Posttreatment facial and intraoral photographs.

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  Figure 7 Posttreatment dental casts.

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  Figure 8 Posttreatment panoramic and cephalometric radiograph.

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  Figure 9 Cephalometric superimposition of pretreatment and posttreatment.

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  Figure 10 Facial and intraoral photographs at 3.5 years of retention.

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  Figure 11 Cephalometric radiograph at 3.5 years of retention and cephalometric superimposition.

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  Figure 12 Electromyography during maximum clenching at pretreatment, posttreatment, and 1 year of retention.

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